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SGLT2 inhibitors
SGLT2 inhibitors
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News & Research:
-
Can SGLT2 Inhibitors Limit
Acute Kidney Injury in Type 2 Diabetes? - Medscape, 3/7/23 -
"people taking
an SGLT2 inhibitor had a relative 25% lower rate of AKI events, while in the
observational studies, SGLT2 inhibitor treatment was linked with a 60% relative
reduction in AKI. The study also found that SGLT2 inhibitor use in the trials
was linked with a significant 20% relative increase in the incidence of low
fluid volume."
-
Empagliflozin and Elderly
Patients With Preserved Ejection Fraction Heart Failure: Is Age Just a Number?
- Medscape, 10/17/22 - "Major molecular regulators of
cellular lifespan are sirtuin-1 (SIRT1) and mammalian target of rapamycin
complex 1 (mTORC1). In a nutrient-deficient or calorie-restricted state, SIRT1
activation, along with adenosine monophosphate-activated protein kinase (AMPK)
and peroxisome proliferator-activated receptor-gamma coactivator (PGC-1α) set
forth a cascade of downstream target activations culminating in deceleration of
cell aging. Suppression of the mTORC1 pathway further augments SIRT1-activated
autophagy, the lysosome-utilizing process of clearing misfolded proteins from
the cytosol. Without healthy autophagy, oxidative stress contributes to impaired
endothelial nitric oxide (NO) pathways, inflammation, cell death, fibrosis, and
cardiomyopathy (adapted from Gevaert et al1). SGLT2 inhibitors are hypothesized
to contribute to activation of SIRT1 and suppression of mTORC1 pathways.10 Akt =
protein kinase B; HFpEF = heart failure with preserved ejection fraction; ROS =
reactive oxygen species ... Aside from the obvious bedside clinical
implications, the findings of Bohm et al[7] cause us to wonder more about the
mechanistic impact of SGLT2 inhibition on multiple cardiovascular and
noncardiovascular therapeutic targets. SGLT2 inhibitors induce glycosuria and
reduce insulin levels, which promotes a ketogenic and fatty acid oxidation
state, mimicking calorie restriction physiology, which has been associated with
cellular stress resistance, attenuation of cellular senescence, and reduced
oxidative stress-induced tissue damage.[9] Such pathway activation is
hypothesized to assuage metabolic disease, alleviate endothelial and vascular
inflammation, and mitigate the clinically observed arterial stiffness associated
with the HFpEF syndrome" - See
empagliflozin inhousepharmacy.vu.
-
Dapagliflozin's HFpEF
Benefit Recasts Heart Failure Treatment: DELIVER - Medscape, 8/27/22 -
"A key finding of DELIVER, confirmed in several combined
analyses also reported at the congress, was that the benefit of dapagliflozin
treatment extended to patients with HFpEF in the highest ranges of ejection
fraction ... Combined analysis of the DELIVER results with the findings from
DAPA-HF in a prespecified analysis that included a total of 11,007 patients with
heart failure across the full spectrum of ejection fraction values (with
individual patients having values as low as less than 20% or as high as more
than 70%) showed a consistent benefit from dapagliflozin treatment for
significantly reducing the combined endpoint of cardiovascular death or
hospitalization for heart failure by about 22%, compared with placebo, across
the complete range of this ejection fraction continuum ... A second,
prespecified combined analysis coupled the DELIVER findings with the results of
a prior large trial that assessed empagliflozin in patients with HFpEF,
EMPEROR-Preserved, which had shown similar findings but with an apparent
diminishment of activity in patients at the highest range of preserved left
ventricular function, with ejection fractions in excess of about 65%, a tail-off
of effect not seen in DELIVER ... SGLT2 inhibitors are the bedrock of therapy
for heart failure regardless of ejection fraction or care setting" - See
dapagliflozin at reliablerxpharmacy.com.
-
SGLT2 Inhibitors Cut AFib
Risk in Real-Word Analysis - Medscape, 6/14/22 -
"But despite documentation like this, real-world evidence also continues to show
limited uptake of SGLT2 inhibitors in U.S. patients with type 2 diabetes.
Records from more than 1.3 million patients with type 2 diabetes managed in the
Veterans Affairs Healthcare System during 2019 or 2022 documented that just 10%
of these patients received an agent from this class, even though all were
eligible to receive it, according to findings in a separate report at the
meeting ... The study's primary endpoint was the incidence of hospitalization
for AFib, which occurred a significant 18% less often in the patients who
started on an SGLT2, compared with those who started a DPP4 inhibitor during
median follow-up of 6.7 months, and a significant 10% less often, compared with
those starting a GLP-1 receptor agonist during a median follow-up of 6.0 months
... in an analysis of more than 130,000 matched pairs, treatment with
empagliflozin was linked to a significant 30% reduction in the incidence of
hospitalization for heart failure, compared with patients treated with a GLP-1
receptor agonist. Analysis of more than 116,000 matched pairs of patients showed
that treatment with empagliflozin linked with a significant 29%-50% reduced rate
of hospitalization for heart failure, compared with matched patients treated
with a DPP4 inhibitor" - See
empagliflozin inhousepharmacy.vu.
-
Dapagliflozin Early
Benefit Explored in Reduced-EF Heart Failure - Medscape, 6/6/22 -
"Functional capacity in heart failure with reduced ejection fraction (HFrEF)
appears to improve within a few weeks of SGLT2-inhibitor initiation, suggests a
small, randomized study that followed peak VO2 in patients with HFrEF assigned
to take dapagliflozin (Farxiga). The benefit observed at 30 days held at a
plateau for at least a few more months ... The new study, called DAPA-VO2 , has
limitations but is consistent with a similar study of empagliflozin (Jardiance),
investigators observed, and could help explain why clinical risk fell off so
rapidly once patients started on SGLT2 inhibitors in major HFrEF trials of these
drugs ... Peak VO2 in the study rose 8% further (P = .021) in patients on
dapagliflozin compared with placebo a month into the trial, the gain persisting
at least to 90 days"
-
SGLT-2 inhibitors as
First-Line Therapy in Type 2 Diabetes? - Medscape, 5/23/22 -
"only two SGLT-2 inhibitors, canagliflozin and
empagliflozin, were shown to have a statistically significant association with
decreased major adverse cardiovascular events ... In contrast, neither
dapagliflozin nor ertugliflozin showed significant benefit regarding those
outcomes ... those four major SLGT-2 inhibitor cardiovascular outcomes trials
were placebo-controlled rather than head-to-head trials in which they were
compared to an active comparator such as metformin ... The majority of patients
were followed for a year or less. This is probably sufficient to assess the
impact of some pharmacological mechanisms, for example, the beneficial impact to
decrease risk of heart failure by promoting urinary sodium excretion. However,
it's probably insufficient time to observe a beneficial impact on
atherosclerosis. For example, there is typically a lag of several years before
statins demonstrate efficacy with respect to adverse cardiovascular events ...
Incidence rates per 1000 person-years for the composite of hospitalization for
MI, hospitalization for ischemic or hemorrhagic stroke, or all-cause mortality
(MI/stroke/mortality) were 15.0 vs 16.2 for SLGT-2 inhibitors vs metformin, not
a significant difference (hazard ratio [HR], 0.96) ... However, for the
composite of heart failure hospitalization or all-cause mortality, the rates
were 18.3 vs 23.5, a significant difference, with an HR of 0.80. The benefit was
seen beginning at about 6 months ... Compared with metformin, SGLT-2 inhibitors
showed a significantly lower risk for heart failure hospitalization (HR, 0.78),
a numerically (but not significantly) lower risk for MI (HR, 0.70), and similar
risks for stroke, mortality, and MI/stroke/HHF/mortality ... Metformin is
considerably less costly than any of the SGLT-2 inhibitors ― roughly $10 to $20
per month, compared to more than $500 a month" - See
empagliflozin inhousepharmacy.vu.
-
Accelerated and personalized
therapy for heart failure with reduced ejection fraction - Eur Heart J 2022
Apr 25 - "The optimal alternative sequences included sodium-glucose cotransporter 2 inhibition and a mineralocorticoid receptor antagonist as the
first two therapies" - See
empagliflozin inhousepharmacy.vu.
-
Mineralocorticoid Receptor Antagonists for Treatment of
Hypertension and Heart Failure - Methodist Debakey
Cardiovasc J. 2015 Oct-Dec - "Spironolactone
and eplerenone are both mineralocorticoid-receptor
antagonists. These compounds block both the epithelial and
nonepithelial actions of aldosterone, with the latter
assuming increasing clinical relevance. Spironolactone and
eplerenone both affect reductions in blood pressure either
as mono- or add-on therapy; moreover, they each afford
survival benefits in diverse circumstances of heart failure
and the probability of renal protection in proteinuric
chronic kidney disease. However, as use of mineralocorticoid-blocking
agents has expanded, the hazards inherent in taking such
drugs have become more apparent. Whereas the endocrine side
effects of spironolactone are in most cases little more than
a cosmetic annoyance, the potassium-sparing effects of both
spironolactone and eplerenone can prove disastrous, even
fatal, if sufficient degrees of hyperkalemia emerge. For
most patients, however, the risk of developing hyperkalemia
in and of itself should not discourage the sensible
clinician from bringing these compounds into play.
Hyperkalemia should always be considered a possibility in
patients receiving either of these medications; therefore,
anticipatory steps should be taken to minimize the
likelihood of its occurrence if long-term therapy of these
agents is being considered"
-
Spironolactone - dermcoll.edu.au -
"Spironolactone is an
anti-male hormone (anti-androgen) medication. It blocks the
male hormone receptor and reduces the level of the male
hormones, testosterone and DHEAS ... Spironolactone has a
diuretic (“fluid tablet”) effect and increases urine
production. This medication lowers blood pressure and
reduces fluid retention seen in conditions such as heart
failure and chronic liver disease. Spironolactone can be
used to treat low potassium levels (hypokalaemia)" -
Note: Lowering testosterone sounds like it would do more
harm then good. I can cite studies to back if up. Maybe what
needs to be lowered is SHBG:
-
Sex
hormone-binding globulin: a new marker of disease severity
and prognosis in men with chronic heart failure - Rev
Esp Cardiol 2009 Dec - "Sex
hormone-binding globulin (SHBG) is a key regulator of the
actions of anabolic steroids. Chronic heart failure (HF) has
been associated with anabolic steroid deficiency, but its
relationship with SHBG is not known ... At enrolment, the
SHBG level (median 34.5 nmol/L, IQR 27-50 nmol/L) was
correlated with the N-terminal probrain natriuretic peptide
level (r=0.271, P=.005), LVEF (r=-0.263, P=.007), body mass
index (r=-0.199, P=.020) and total testosterone level
(r=0.332, P=.001). The median SHBG level was higher in the
16 patients (15.4%) who died, at 48.5 nmol/L (IQR 36-69.5
nmol/L) vs. 33 nmol/L (IQR 25.3-48.7 nmol/L; P=.001), and a
high level was associated with an increased risk of death
(hazard ratio [HR]=1.045, 95% confidence interval [CI]
1.021-1.069; P< .001). The association remained significant
after adjustment in Cox multivariate regression modeling, at
HR=1.049 (95% CI 1.020-1.079; P=.001). Analysis by SHBG
tertiles showed mortality was 30% in the third tertile, 14%
in the second, and 4% in the first (log rank 0.007; HR=3.25
... The SHBG level correlated with measures of HF severity
and was associated with a higher risk of cardiac death"
-
Empagliflozin Rapidly
Improves Acute Heart Failure Symptoms in Hospitalized Patients - Medscape,
4/14/22 - "The trial randomized patients hospitalized
for acute heart failure after a brief period of stabilization regardless of
their left ventricular ejection fraction or presence of diabetes to receive a
single, daily dose of 10 mg of empagliflozin (Jardiance) or placebo starting a
median of 3 days after admission ... Using a “win ratio” method for analyzing
the composite endpoint, the primary analysis showed that treatment with
empagliflozin for 90 days boosted the win ratio by a significant 36% relative to
placebo (Nature Med. 2022 Mar;28[3]: 568-74) ... EMPULSE is the second trial to
show that an SGLT2 inhibitor can safely and effectively treat patients
hospitalized for acute heart failure. Previously, results from the SOLOIST-WHFpivotal
trial, which enrolled 1,222 patients with type 2 diabetes recently hospitalized
for worsening heart failure, showed that treatment with an investigational,
combined SGLT2 and SGLT1 inhibitor, sotagliflozin, resulted in a significant,
33% relative reduction in the primary outcome compared with placebo after a
median 9 months of treatment."
-
Heart Failure With
Preserved Ejection Fraction: New Treatments Provide 'Hope' - Medscape,
3/28/22 - "That is, those individuals in PARAGON-HF who
had ejection fractions slightly on the lower end of "normal" tended to benefit
more from this medication as well. That differentiated by sex. This is a
controversial aspect of the field and it is something that's evolving on a
day-to-day or month-to-month basis ...
Sacubitril-valsartan, I
think, would be a medicine that could be of particular benefit in this patient.
That was the first of the next few trials in HFpEF
that started to yield potential new drug classes for HFpEF. ... The next drug
class is one with which all aspects of cardiology have become more and more
aware, and the HFpEF field is no stranger. With the results of the
EMPEROR-Preserved trial we have, in the history of HFpEF clinical trials, our
first positive trial, and a monumental moment. A trial evaluating the efficacy
of empagliflozin (a sodium-glucose cotransporter 2 [SGLT2] inhibitor) vs placebo
in HFpEF. This is the ideal patient who may benefit from this medicine ...
EMPEROR-Preserved demonstrated a reduction in a composite endpoint of heart
failure hospitalization and cardiovascular death. As you mentioned, Clyde, this
efficacy was driven by a reduction in heart failure hospitalization. The class
of SGLT2 inhibitors would be, certainly, a medicine that would provide much
benefit not only from a reduction in heart failure hospitalization perspective,
but a marked improvement in symptoms" - See
empagliflozin at ihouseepharmacy.
-
SGLT2 Inhibitors May Cut
Repeat Syncope in Type 2 Diabetes - Medscape, 2/16/22 -
"vaso-vagal syncope (VVS) ... Patients treated with an
SGLT2 inhibitor at entry had a significant (45%) reduction in their incidence of
VVS during 1-year follow-up compared with the patients not on SGLT2 inhibitor
treatment in a Cox multiple regression analysis that included multiple potential
demographic and clinical confounders, including age, smoking status, body mass
index, heart rate, and beta blocker use" - See
empagliflozin at ihouseepharmacy.
-
What to know about vasovagal syncope -
medicalnewstoday.com - "The term
vasovagal syncope (VVS) describes fainting that occurs in
response to a sudden drop in heart rate or blood pressure.
The resulting lack of blood and oxygen to the brain is what
causes a person to pass out"
-
US Underuse of GLP-1RA,
SGLT-2i in Type 2 Diabetes Persists - Medscape, 2/15/22 -
"Only 11% to 14% of US adults with type 2 diabetes
received treatment with a glucagon-like peptide-1 receptor agonist (GLP-1RA) or
with a sodium glucose cotransporter-2 (SGLT2) inhibitor from 2018 to 2020
despite clear indications for their use ... Why This Matters ... Agents from
both the GLP-1RA and SGLT-2 inhibitor classes confer protection against major
atherosclerosis-based adverse cardiovascular events in patients with
atherosclerotic cardiovascular disease (ASCVD). SGLT-2 inhibitors also lower the
risk of hospitalization for heart failure and prevent worsening kidney function
in patients with type 2 diabetes and ASCVD risk or with diabetic kidney disease"
-
SGLT2 Inhibitors in Older
Adults with Heart Failure with Preserved Ejection Fraction - Drugs Aging
2022 Feb 4 - "Until now, empagliflozin is the first
therapy that has convincingly been shown to improve clinical outcome in HFpEF.
Importantly, some key points should be considered to better understand the
impact of empagliflozin on the patient trajectory, particularly in older adults
with HFpEF. In this current opinion article, we have therefore provided more
information on how to translate the findings of the EMPEROR-Preserved trial to
the setting of older adults, with a focus on the impact of empagliflozin on
hospitalizations, both heart failure-related and all-cause. To better understand
the importance of EMPEROR-Preserved findings, we compared these findings with
previous relevant HFpEF and heart failure with reduced ejection fraction (HFrEF)
trials and provided information on ongoing trials in the HFpEF setting"
- See
empagliflozin at ihouseepharmacy.
-
Primary Prevention of
Cardiovascular and Heart Failure Events With SGLT2 Inhibitors, GLP-1 Receptor
Agonists, and Their Combination in Type 2 Diabetes - Diabetes Care 2022 Jan
31 - "major adverse cardiac and cerebrovascular events
(MACCE) and heart failure (HF) ... SGLT2i and SGLT2i/GLP-1RA combination
regimens may be beneficial in primary prevention of MACCE and HF and GLP-1RA for
HF"
-
Glucagon-Like Peptide 1
Receptor Agonists and Sodium-Glucose Cotransporter 2 Inhibitors and Risk of
Nonalcoholic Fatty Liver Disease Among Patients With Type 2 Diabetes -
Diabetes Care 2022 Feb 1 - "To determine whether
glucagon-like peptide 1 receptor agonists (GLP-1 RA) and sodium-glucose
cotransporter 2 (SGLT-2) inhibitors, separately, are associated with a decreased
risk of nonalcoholic fatty liver disease (NAFLD) compared with dipeptidyl
peptidase 4 (DPP-4) inhibitors among patients with type 2 diabetes ... SGLT-2
inhibitors, and possibly GLP-1 RA, may be associated with a decreased incidence
of NAFLD and hepatic transaminase elevation among patients with type 2 diabetes"
-
SGLT2 in Patients With
Type 2 Diabetes Lowers Risk of Gout - Medscape, 2/8/22 -
"During a median 5.6-year follow-up, treatment with an
SGLT2 inhibitor was associated with a 54% (P < .0001) lower rate of incident
gout and a 62% (P < .0001) lower rate of all-cause mortality compared with DDP4
inhibitors in propensity-score matched groups in a multivariable Cox analysis,
after adjustment for significant demographics, past comorbidities, other drug
use, and subclinical biomarkers"
-
SGLT-2 Inhibitors,
GLP1-RAs Show Cardiorenal Event Prevention in Meta-analysis - Medscape,
1/31/22 - "Among three classes of newer antidiabetic
drugs, sodium glucose cotransporter-2 (SGLT-2) inhibitors were the most
effective for reducing cardiovascular deaths, renal events, and hospitalizations
for heart failure (HHF) in patients with or without diabetes"
-
Lower Blood Sugar Levels Extends Lifespan
- SGLT2 - Dr. Brad Stanfield, YouTube - See
empagliflozin at ihouseepharmacy. Here are the studies discussed in the
video:
-
Canagliflozin extends life span in genetically heterogeneous
male but not female mice
- JCI Insight 2020 Nov 5 - "Cana
extended median survival of male mice by 14% ... with
parallel effects seen at each of 3 test sites ... Cana led
to lower fasting glucose and improved glucose tolerance in
both sexes, diminishing fat mass in females only ... Cana is
likely to reflect blunting of peak glucose levels, because
similar longevity effects are seen in male mice given
acarbose, a diabetes drug that blocks glucose surges through
a distinct mechanism, i.e., slowing breakdown of
carbohydrate in the intestine" - See
canagliflozin at
inhousepharmacy.vu but from what I've read over the years,
empagliflozin is a better SGLT2i. For one thing, it
produces twice the blood pressure reduction. See
empagliflozin inhousepharmacy.vu.
-
SGLT2
inhibitors for primary and secondary prevention of
cardiovascular and renal outcomes in type 2 diabetes: a
systematic review and meta-analysis of cardiovascular
outcome trials - Lancet 2019 Jan 5 -
"systematic review and meta-analysis
of randomised, placebo-controlled, cardiovascular outcome
trials of SGLT2i in patients with type 2 diabetes ... 34 322
patients ... SGLT2i reduced major adverse cardiovascular
events by 11% ... SGLT2i reduced the risk of cardiovascular
death or hospitalisation for heart failure by 23% (0·77
[0·71-0·84], p<0·0001), with a similar benefit in patients
with and without atherosclerotic cardiovascular disease and
with and without a history of heart failure. SGLT2i reduced
the risk of progression of renal disease by 45%"
-
Sodium-Glucose Cotransporter-2 Inhibitor (SGLT2i) as a
Primary Preventative Agent in the Healthy Individual: A Need
of a Future Randomised Clinical Trial? - Front Med
(Lausanne) 2021 Aug 23 - "SGLT2i
used as a monotherapy are all associated with a low risk of
developing hypoglycaemia ... clinical trials in China found
that SGLT2i monotherapy was not observed with increased
hypoglycaemia risk ... The widespread use of SGLT2i in
recent years has been associated with a slightly increased
risk of diabetic ketoacidosis ... A recent review (55)
discussed the indirect mechanism of reno-protective benefit
with SGLT2i, which includes reducing hyperglycaemia,
lowering blood pressure, decreasing uric acid, promoting
weight loss, increasing glucagon level, reducing insulin
level and promoting diuresis ... non-diabetic CKD patients
and have proved to delay the progression of kidney disease,
lower the risk of cardiovascular events and improve survival
rates, highlighting their use beyond the scope of only
diabetic patients ... BP reduction was observed in Phase III
studies with the average 5.5 mmHg decrease in systolic and
the average 1.5 mmHg decrease in diastolic BP ... recent
review (55) discussed the indirect mechanism of reno-protective
benefit with SGLT2i, which includes reducing hyperglycaemia,
lowering blood pressure, decreasing uric acid, promoting
weight loss, increasing glucagon level, reducing insulin
level and promoting diuresis ... Obesity is well established
to be an independent risk factor for cardiovascular disease
(81). SGLT2i promote weight loss via glycosuria and negative
energy balance, thereby leading to significant weight loss
... Taking all the evidences together, there is a need for
consideration of SGLT2i as a potential agent for primary
prevention clinical trial in low-risk of cardiovascular and
renal diseases or even healthy population with research
design focusing on ensuring its safety and minimising
potential side effects" -
-
A
longitudinal assessment of the natural rate of decline in
renal function with age - J Nephrol 2014
Dec;27(6):635-41 - "annual rate of
decline in eGFR in healthy subjects was 0.97 ± 0.02
ml/min/year/1.73 m(2). This decline increased significantly
from 0.82 ± 0.22 in age-group 20-30 years to 0.84 ± 0.08,
1.07 ± 0.08 and 1.15 ± 0.12 ml/min/year/1.73 m(2) in age
groups 31-40, 41-50 and 50 years and older respectively"
-
Longer lifespan in male mice treated with a weakly
estrogenic agonist, an antioxidant, an α‐glucosidase
inhibitor or a Nrf2‐inducer - Aging Cell 2016
Oct;15(5):872-84 "Metformin alone,
at a dose of 0.1% in the diet, did not significantly extend
lifespan" - See
protandim at Amazon.com.
-
Protandim® - Alzheimer's Drug Discovery Foundation -
"May be more useful to take the
individual antioxidant ingredients at doses associated
with therapeutic benefit than this combination which has
no clear clinical value ... Protandim® is a patented
blend of 5 herbal ingredients with antioxidant activity:
milk thistle (Silybum marianum) extract (225 mg), bacopa
(Bacopa monnieri) extract (150 mg), ashwagandha (Withania
somnifera) root (150 mg), green tea (Camellia sinensis)
extract (75 mg), and turmeric (Curcuma longa) extract
(75 mg) ... Protandim® chow supplementation (equivalent
to human supplement dosage) led to a 7% increase in
median survival (p< 0.012) in male mice but had no
effect on survival in females or in maximum survival
(p=0.1) of either sex"
-
SGLT2 Inhibitors Improve
Cardiovascular Outcomes Across Groups - Medscape, 1/6/22 -
"The findings, from a meta-analysis of 10 major
randomized clinical trials, were published online January 5 in JAMA Network Open
by Mukul Bhattarai, MD, a cardiology fellow at the Southern Illinois University
School of Medicine, Springfield, Illinois, and colleagues ... Among a total of
71,553 high-risk patients, 39,053 received an SGLT2 inhibitor and 32,500
received a placebo ... The primary outcome of cardiovascular death or
hospitalization for heart failure occurred in 8.10% randomized to SGLT2
inhibitors compared with 11.56% in the placebo group, a significant difference
with odds ratio 0.67 ... Patients receiving SGLT2 inhibitors also had
significantly lower rates of major adverse cardiovascular events, defined as
death due to cardiovascular causes, nonfatal myocardial infarction, or nonfatal
stroke. Those events occurred in 9.82% vs 10.22%, with an odds ratio of 0.90 ...
Hospitalizations and emergency department visits with heart failure were also
reduced with SGLT2 inhibitors (4.37% vs 6.81%; odds ratio, 0.67; P < .001), as
was cardiovascular death (4.65% vs 5.14%; odds ratio, 0.87" - See
empagliflozin inhousepharmacy.vu.
-
SGLT2 Inhibitors in
Primary Care: 'All Hands on Deck' for Improving Heart Failure Outcomes -
Medscape, 12/23/21 - "SGLT2 inhibitors lower blood sugar
concentrations by blocking the reabsorption of glucose by the kidneys. They also
at least transiently increase urinary sodium excretion which along with a number
of other mechanisms may provide benefits in heart failure ... It often takes
years for effective new therapies to reach patients after positive results of
clinical trials and inclusion in practice guidelines ... If you are seeing a
patient with heart failure that is not on an SGLT2 inhibitor, definitely
consider starting so long as there are no prevailing contraindications, and keep
their specialists in the loop ... Heart failure patients are going to see
various generalists and specialists, so the clinician who should be prescribing
SGLT2 inhibitors is whoever has the opportunity to do so" - See
dapagliflozin at reliablerxpharmacy.com. They don't carry
empagliflozin.
-
The
diabetes medication that could revolutionize heart failure treatment -
Science Daily, 12/1/21 - "For many years there was not a
single medicine that could improve the outcome in patients with the second type
of heart failure -- those patients with preserved ejection fraction ... SGLT2
inhibitors are more commonly known under their trade-names Forxiga
(Dapagliflozin), Invokana (Canagliflozin), and Jardiance (Empagliflozin) ... We
found that patients taking SGLT2 inhibitors were 22 per cent less likely to die
from heart-related causes or be hospitalised for heart failure exacerbation than
those taking placebo" - See
dapagliflozin at reliablerxpharmacy.com.
-
SGLT2 Inhibitor Use Tied
to Fewer Atrial Arrhythmias - Medscape, 12/2/21 -
"treatment with an SGLT2 inhibitor was tied to a significant 23% relative
reduction in atrial arrhythmia events and a 44% relative drop in all-cause death
... "We think that a reduction in left atrial pressure" produced by treatment
with an SGLT2 inhibitor "may be linked to the reduction in atrial arrhythmias."
- See
dapagliflozin at reliablerxpharmacy.com.
Abstracts:
-
Pioglitazone, SGLT2
inhibitors and their combination for primary prevention of cardiovascular
disease and heart failure in type 2 diabetes: real-world evidence from a
nationwide cohort database - Diabetes Res Clin Pract 2023 Apr 24 -
"Compared with the reference group, the
pioglitazone/SGLT2i combination group had a significantly lower risk for MACE (aHR,
0.76, 95% CI 0.66-0.88) and heart failure (aHR 0.67, 95% CI 0.55-0.82).
Pioglitazone was associated with a lower risk of MACE (aHR, 0.82, 95% CI
0.71-0.94) and there was no difference in risk of heart failure compared with
the reference group. The incidence of heart failure was significantly decreased
in the SGLT2i group (aHR 0.7, 95% CI 0.58-0.86)" - See
Pioglitazone at ReliableRXPharmacy and
empagliflozin inhousepharmacy.vu.
-
Effects of the
Sodium-Glucose Cotransporter Inhibitors on Cardiovascular Death and All-Cause
Mortality: A Systematic Review and Meta-analysis of Randomized
Placebo-Controlled Clinical Trials - Am J Cardiovasc Drugs 2023 Mar;23 -
"Sodium-glucose cotransporter inhibitors significantly
reduced major adverse cardiovascular events, including hospitalization and
all-cause mortality in patients with or without established atherosclerotic
cardiovascular disease. We observed a beneficial trend in patients with heart
failure with preserved ejection fraction, and no benefits in patients with
stroke or myocardial infarction."
-
Cardiovascular and renal
effects of SGLT2 inhibitor initiation in acute heart failure: a meta-analysis of
randomized controlled trials - Clin Res Cardiol 2023 Jan 2 -
"The addition of SGLT2i to conventional therapy for AHF
reduced all-cause death (odds ratio [OR] 0.75; 95% CI 0.56-0.99; p = 0.049),
readmissions for heart failure (HF) (OR 0.54; 95% CI 0.44-0.66; p < 0.001), and
the composite of cardiovascular death and readmissions for HF (hazard ratio
0.71; 95% CI 0.60-0.84; p < 0.001). Furthermore, SGLT2i increased mean daily
urinary output in liters (mean difference [MD] 0.45; 95% CI 0.03-0.87; p =
0.035) and decreased mean daily doses of loop diuretics in mg of furosemide
equivalent (MD -34.90; 95% CI [- 52.58, - 17.21]; p < 0.001) without increasing
the incidence worsening renal function (OR 0.75"
-
SGLT2 inhibitors reduce
adverse kidney and cardiovascular events in patients with advanced diabetic
kidney disease: a population-based propensity score-matched cohort study -
Diabetes Res Clin Pract 2022 Dec 5 - "SGLT2 inhibitor
improved kidney function, glycemic profile, and reduced adverse kidney-related
and cardiovascular events in diabetic patients with advanced CKD"
-
Sodium-Glucose Cotransporter
2 Inhibitors for Non-Alcoholic Fatty Liver Disease in Patients with Type 2
Diabetes Mellitus: A Nationwide Propensity-Score Matched Cohort Study -
Diabetes Res Clin Pract 2022 Nov 25 - "fatty liver index
(FLI) ... SGLT2i showed a significant reduction in FLI and its components. We
suggest that SGLT2i may have beneficial effects in reducing the prevalence of
NAFLD in type 2 diabetes" - See
empagliflozin inhousepharmacy.vu.
-
Liver autophagy-induced
valine and leucine in plasma reflect the metabolic effect of sodium glucose
co-transporter 2 inhibitor dapagliflozin - EBioMedicine 2022 Nov 21 -
"Sodium glucose co-transporter 2 (SGLT2) inhibitors are
anti-diabetic drugs for type 2 diabetes that lower blood glucose levels and body
weight. It is of special interest that SGLT2 inhibitors also improve liver
metabolism and fatty liver. Liver is an important organ in regulation of energy
metabolism, but the metabolic action of SGLT inhibitors in liver remains unclear
... Clinical study found that valine and leucine levels were markedly higher in
patients treated with dapagliflozin (valine: P < 0·05 vs. control, leucine: P <
0·01 vs. control) than those not treated after one week intervention ...
Dapagliflozin improves liver metabolism via hepatic autophagy, and plasma valine
and leucine levels may reflect its metabolic effect"
-
Effects of fish oil on
methotrexate-induced reproductive damage in rats - Andrologia 2022 Nov 11 -
"Methotrexate (MTX) is a folic acid antagonist that is
commonly used in paediatric and adult oncology to treat a variety of
malignancies. Internal organs, including the testis, are severely cytotoxic and
genotoxic to MTX. Omega-3, as an antioxidant, has been shown to protect rat
testis tissue from injury. The effect of fish oil (FO) on MTX-induced
reproductive damage in rats was investigated in this work ... All sperm quality
measures were significantly lowered in the MTX group, while FO had a recovery
effect. There were no notable variations in histopathology across groups except
for germ cell thickness, which reduced considerably in the MTX group and
recovered with FO treatment. As a result, FO has been shown to reduce testicular
toxicity following MTX treatment in rats" - See
empagliflozin inhousepharmacy.vu.
-
Impact of Inpatient
Initiation of Sodium-Glucose Cotransporter-2 Inhibitors on Prescription Rates in
Patients With Heart Failure With Reduced Ejection Fraction - Am J Cardiol
2022 Oct 22 - "The heart failure readmission rate in the
first 30 days was significantly lower in those with inpatient initiation of
SGLT2i compared with those who did not start during hospitalization. (9.3% vs
22.7%, p = 0.04). Cardiovascular mortality was numerically, but not
significantly, different between groups (4% vs 10.7%, p = 0.21). Inpatient
initiation of an SGLT2i was associated with a significantly higher postdischarge
rate of SGLT2i prescriptions and significantly lower heart failure readmission
rates at 30 days. In conclusion, these findings highlight the importance of
initiating SGLT2i during inpatient hospitalization to improve the quality of
care in patients with HFrEF"
-
Sodium-glucose cotransporter
2 inhibitors and the risk of pneumonia and septic shock: A systematic review and
meta-analysis - J Clin Endocrinol Metab 2022 Oct 1 -
"Compared to placebo, SGLT2i significantly reduced the risk of pneumonia (pooled
RR 0.87, 95% CI 0.78-0.98) and septic shock (pooled RR 0.65"
-
Heart Failure with Preserved
Ejection Fraction and Obstructive Sleep Apnea: A Novel Paradigm for Additional
Cardiovascular Benefit of SGLT2 Inhibitors in Subjects With or Without Type 2
Diabetes - Adv Ther 2022 Sep 16 - "we emphasized the
promising role of SGLT2is in prevention, rehabilitation, and treatment of
patients with OSA regardless of coexisting type 2 diabetes (T2DM). Indeed,
SGLT2is enhance lipolysis and fatty acid beta-oxidation. These phenomena might
prevent OSA by reducing the size of visceral and subcutaneous adipose tissue
and, as proven in humans and animals with T2DM, counteract NAFLD onset and
progression. The aforementioned mechanisms may represent an additional SGLT2i
cardioprotective effect in terms of HFpEF prevention in patients with OSA, whose
NAFLD prevalence is estimated to be over 50%"
-
Incident heart failure,
arrhythmias and cardiovascular outcomes with sodium glucose co-transporter 2
(SGLT2) inhibitor use in diabetic patients: Insights from a global federated
electronic medical record database - Diabetes Obes Metab 2022 Aug 31 -
"The risk of incident HF was significantly lower in the
SGLT2i cohort compared to the non-SGLT2i cohort (HR 0.70, 95%CI 0.68-0.73).
SGLT2i use was also associated with a significantly lower risk of all-cause
mortality (HR 0.61, 95% CI 0.58-0.64), cardiac arrest (HR 0.70, 95% CI
0.63-0.78), incident AF (HR 0.81, 95% CI 0.76-0.84), ischaemic stroke/TIA (HR
0.90, 95% CI 0.88-0.93), composite of arterial and venous thrombotic events (HR
0.90, 95% CI 0.88-0.92), and composite of incident VT/VF and cardiac arrest (HR
0.76, 95% CI 0.71-0.81). There were no significant differences for VT/VF (HR
0.94"
-
SGLT2 Inhibitors Lower
NAFLD, HCC Risks Over DPP4i - Medscape, 9/1/22 -
"After 239941.9 person-years of follow-up, the incidence of HCC was lower among
SGLT2I users (IR, 0.3; 95% CI, 0.2 – 0.4) than among DPP4i users (IR,1.3; 95%
CI,1.1 – 1.5) ... Among SGLT2i users, the risk of cancer-related mortality was
lower (IR, 1.1; 95% CI, 0.9 – 1.3) than among DPP4i users (IR, 6.6; 95% CI, 6.1
– 7.1), as was the risk of all-cause mortality (IR, 5.0; 95% CI, 4.6 – 5.4) in
comparison with DPP4i users (IR, 24.4; 95% CI, 23.6 – 25.4) ... In multivariable
models, the risk of NAFLD was lower among SGLT2i (hazard ratio [HR], 0.39; 95%
CI, 0.34 – 0.46), HCC (HR, 0.46; 95% CI, 0.29 – 0.72), cancer-related mortality
(HR, 0.29; 95% CI, 0.23 – 0.37) and all-cause mortality (HR, 0.28; 95% CI, 0.25
– 0.31) after adjustments" - See
empagliflozin inhousepharmacy.vu.
-
SGLT2 inhibitor ameliorates
high-fat diet induced hypothalamic-pituitary-ovarian axis disorders - J
Physiol 2022 Sep 1 - "The pathways for how SGLT2
inhibitors have neuroprotective properties is that A. Inhibition of microglial
activation results in decreasing proinflammatory factors release and
neuroinflammation; B. Alleviation of cerebral atherosclerosis; C. Reduction of
oxidative stress in neuron; D. Inhibition of ROS-dependent neuronal apoptosis"
-
The Role of SGLT2 Inhibitor
Ipragliflozin on Cardiac Hypertrophy and microRNA Expression Profiles in a
Non-diabetic Rat Model of Cardiomyopathy - Biol Pharm Bull 2022 -
"These findings suggest that miRNAs may play a partial
role in regulating the structure of the heart and that SGLT2 inhibitors may
exert cardio-protective effects by changing miRNA expression profiles in
non-diabetic patients with CVDs"
-
Possible Mechanism of Hematocrit Elevation by Sodium Glucose Cotransporter 2
Inhibitors and Associated Beneficial Renal and Cardiovascular Effects -
Circulation 2019 Apr 23 - "SGLT2 inhibitor therapy is
associated with a modest increase in hematocrit (2%–4%) relative to placebo, and
this effect is consistent for all 4 SGLT2 inhibitors (empagliflozin,
canagliflozin, dapagliflozin, and ertugliflozin)"
-
"Use of sodium-glucose
co-transporter 2 inhibitors, changes in body mass index and risk of fracture: a
population-based cohort study" - Diabetes Res Clin Pract 2022 Jul 13 -
"SGLT-2 inhibitor use was not associated with increased
osteoporotic fracture risk, irrespective of change in BMI. However, a high
cumulative dose could be an important risk factor" - See See
empagliflozin inhousepharmacy.vu.
-
Could a Type 2 Diabetes
Drug Tackle Kidney Stones? - Medscape, 6/20/22 -
"Patients with type 2 diabetes who received empagliflozin, a sodium glucose
cotransporter-2 (SGLT2) inhibitor, were almost 40% less likely to have a kidney
stone than patients who received placebo during a median 1.5 years of treatment
... Because SGLT2 inhibitors increase urinary glucose excretion through reduced
renal reabsorption of glucose leading to osmotic diuresis and increased urinary
flow, they hypothesized that these therapies "may reduce the risk of upper
urinary tract stones (nephrolithiasis) by reducing the concentration of
lithogenic substances in urine."
-
Comparative efficacy of
novel antidiabetic drugs on cardiovascular and renal outcomes in patients with
diabetic kidney disease: A systematic review and network meta-analysis -
Diabetes Obes Metab 2022 Jun 6 - "A clear advantage was
demonstrated by SGLT2 inhibitors in reducing the risks of CV and renal events in
patients with DKD, compared to GLP-1RAs and DPP-4 inhibitors. We recommend that
SGLT2 inhibitors be considered the treatment of choice in patients with DKD"
- - See
empagliflozin inhousepharmacy.vu.
-
Dapagliflozin Attenuates
Sympathetic and Pressor Responses to Stress in Young Prehypertensive
Spontaneously Hypertensive Rats - Hypertension 2022 Jun 2 -
"These data demonstrate a novel role for SGLT2i in
reducing resting BP as well as the activity of skeletal muscle reflexes,
independent of glycemic control. Our study may have important clinical
implications for preventing hypertension and hypertensive heart disease in young
prehypertensive individuals" - See
dapagliflozin at reliablerxpharmacy.com and
empagliflozin inhousepharmacy.vu. From what I've read,
empagliflozin sounds like a better product.
-
SGLT-2 Inhibitors for
Patients with Heart Failure: What Have We Learned Recently? - Curr
Atheroscler Rep 2022 Jun 2 - "Heart failure (HF); Heart
failure with preserved ejection fraction (HFpEF); Heart failure with reduced
ejection fraction (HFrEF); Sodium-glucose cotransporter-2 inhibitors (SGLT-2i)"
-
Canagliflozin and Atrial
Fibrillation in Type 2 Diabetes Mellitus: A secondary analysis from the CANVAS
Program and CREDENCE trials and meta-analysis - Diabetes Obes Metab 2022 May
19 - "atrial fibrillation/flutter (AF/AFL) ...
Meta-analysis suggests SGLT2 inhibition reduces AF/AFL incidence"
-
Skin dryness induced in the
KK-Ay/TaJcl type 2 diabetes mouse model deteriorates following dapagliflozin
administration - Biol Pharm Bull 2022 May 17 -
"SGLT-2 inhibitors cause skin dryness ... Dapagliflozin treatment decreased
collagen type I and hyaluronic acid levels in mice; additionally, it affected
the TGF-β/hyaluronan synthase pathway, further reducing hyaluronic acid levels.
The results indicate that the reduction in hyaluronic acid levels plays an
important role in the occurrence of dry skin in diabetes" - See
collagen supplements at Amazon.com and
hyaluronic acid at Amazon.com.
-
Pleiotropic effects of SGLT2
inhibitors and heart failure outcomes - Diabetes Res Clin Pract 2022 May 13
- "Heart failure (HF) represents a major public health
concern with increasing prevalence among aging populations, with multifactorial
pathophysiology including inflammation, oxidative stress, endothelial
dysfunction, and fibrosis, among others. Lately, the use of sodium-glucose
cotransporter-2 (SGLT2) inhibitors, originally destined for the treatment of
type 2 diabetes mellitus, have revolutionized the treatment of HF ... Owing to
the results of experimental studies, several pleiotropic effects of SGLT2
inhibitors have been proposed, including the restoration of autophagy which may
be significant in the reversal of the aforementioned HF pathophysiology
according to a latest hypotheses. Additional mechanisms consist of the
regulation of inflammatory, oxidative, and fibrotic pathways, together with the
improvement of endothelial function and reduction of epicardial adipose tissue.
Other than their role as antidiabetic agents, a reduction in heart failure
hospitalizations has been noted following their use in clinical trials,
irrespective of DM status and degree of systolic dysfunction" - See
empagliflozin at ihouseepharmacy.
-
SGLT2 Inhibitors: The
Statins of the 21st Century - Eur Heart J. 2022;43(11):1029-1030 -
"A relatively small number of drugs have been
responsible for major advances in medical practice. The discovery, development,
and elucidation of the mechanisms of action of aspirin, penicillin, and statins
are remarkable success stories, each with some surprises and each crowned by a
Nobel Prize. The sodium glucose co-transporter inhibitors have been proven
effective in the treatment of type 2 diabetes mellitus, various forms of heart
failure, and kidney failure and represent the, or one of the, major
pharmacological advances in cardiovascular medicine in the 21st century ... In
1886, phlorizin was found to be glucosuric. Almost a century later, it was shown
to be a competitive inhibitor of the active reabsorption of glucose by the
proximal renal tubules and to reduce circulating glucose in diabetic rodents. In
the 1990s, the first orally active derivatives of phlorizin, the SGLT2is, were
developed. The first drugs in this class were approved for control of
hyperglycaemia in patients with T2DM in 2012. The first large clinical endpoint
trial in T2DM patients with cardiovascular disease was reported in 2015. In the
past 6 years, other large clinical endpoint trials on several agents in this
class led to four new treatment paradigms. The management of T2DM, of heart
failure in patients with and without T2DM, across a wide range of ventricular
function, as well as of diabetic renal disease have all been substantially
improved by the development of the SGLT2is ... The question recently posed by
Freaney et al 'Could flozins be the statins for risk-based primary prevention of
heart failure?'[14] can now be answered affirmatively!" - See
empagliflozin at ihouseepharmacy.
-
Sodium-glucose Cotransporter
2 Inhibitors and Risk of Hyperkalemia in People with Type 2 diabetes: A
Meta-analysis of Individual Participant Data from Randomized Controlled Trials
- Circulation 2022 Apr 8 - "SGLT2 inhibitors reduce the
risk of serious hyperkalemia in people with type 2 diabetes at high
cardiovascular risk and/or with CKD, without increasing the risk of hypokalemia"
-
Association Between Use of
Sodium-Glucose Co-Transporter-2 (SGLT2) Inhibitors and Cognitive Function in a
Longitudinal Study of Patients with Type 2 Diabetes - J Alzheimers Dis 2022
Mar 21 - "Our findings revealed a previously unobserved
association between ≥3 years SGLT2i use and improved cognitive scores globally
and in language domain and executive function"
-
Sodium-glucose
co-transporter 2 inhibitor therapy: use in chronic kidney disease and adjunctive
sodium restriction - Intern Med J 2022 Mar 7 -
"Hence, blood pressure (BP) reduction is a vital component of CKD management.
Sodium-glucose co-transporter 2 (SGLT2) inhibitors are a relatively novel class
of medications developed to treat T2DM by inducing glycosuria and hence,
lowering glycaemia. Additionally, SGLT2 inhibitors are antihypertensive,
renoprotective and cardioprotective, even in individuals without T2DM, making
them promising therapeutic agents for CKD, regardless of aetiology"
-
Beneficial cardiovascular
and remodeling effects of SGLT2 inhibitors: pathophysiologic mechanisms -
Expert Rev Cardiovasc Ther 2022 Mar 23 - "The analysis
of data clearly demonstrated that the use of the SGLT2 inhibitors besides their
antidiabetic effects, provide additional protection against CVD, CAD, and HFrEF
and HFpEF, and death, but not stroke, in both diabetic and non-diabetic
patients. Therefore, they should be preferably used for the treatment of
patients with T2DM with preexisting CVD, CAD, and HFrEF and HFpEF" - See
empagliflozin at ihouseepharmacy.
-
A Systematic Review and
Network Meta-Analysis of Pharmacological Treatment of Heart Failure With Reduced
Ejection Fraction - Medscape, 3/21/22 - "In patients
with HF with reduced ejection fraction, the estimated aggregate benefit is
greatest for a combination of ARNi, BB, MRA, and SGLT2i"
-
Cardiorenal
protective effects of sodium-glucose cotransporter 2 inhibition
in combination with angiotensin II type 1 receptor blockade in
salt-sensitive Dahl rats - J Hypertens 2022 Mar 11 -
"Inhibition of SGLT2 in combination with
an angiotensin II receptor blocker effectively improved BP salt
sensitivity by reducing renal expression levels of sodium
transporters including NHE3 and NKCC2, which eventually led to
improvement of BP salt sensitivity and cardiorenal protection"
- See
empagliflozin inhousepharmacy.vu.
-
Efficacy of Off-Label
Therapy for Non-alcoholic Fatty Liver Disease in Improving Non-invasive and
Invasive Biomarkers: A Systematic Review and Network Meta-Analysis of Randomized
Controlled Trials - Front Med (Lausanne) 2022 Feb 25 -
"To evaluate the effects of vitamin E, pioglitazone,
sodium-glucose cotransporter-2 (SGLT2) inhibitors, and glucagon-like peptide-1
(GLP-1) receptor agonists in patients with non-alcoholic fatty liver disease
(NAFLD) ... The outcome measures included changes in non-invasive tests [alanine
aminotransferase (ALT), aspartate aminotransferase (AST), gamma-glutamyl
transferase (GGT), controlled attenuation parameter (CAP), enhanced liver
fibrosis (ELF) score, liver fat content (LFC), and keratin-18 (K-18)] and
invasive tests ... δ-Tocotrienol was superior to placebo in decreasing the GGT
level. Semaglutide, ipragliflozin, and pioglitazone induced a significantly
higher decrease in the ALT level than a placebo. Semaglutide, pioglitazone, and
dapagliflozin were superior to placebo in decreasing the AST level.
Tofogliflozin and pioglitazone induced a significantly higher decrease in the
K-18 level than a placebo. Liraglutide was superior to placebo in decreasing
CAP. Liraglutide, pioglitazone, and vitamin E induced a significantly higher
increase in resolution of NASH than a placebo. As for pairwise comparisons,
semaglutide and pioglitazone were superior to liraglutide in decreasing the ALT
level. Semaglutide induced a significantly higher decrease in the ALT level than
dulaglutide. Semaglutide was obviously superior to empagliflozin, liraglutide,
dulaglutide, and tofogliflozin in decreasing the AST level. Pioglitazone induced
a significantly higher decrease in the GGT level than ipragliflozin.
δ-Tocotrienol was superior to liraglutide in decreasing the GGT level.
Tofogliflozin and pioglitazone induced a significantly higher decrease in the
K-18 level than dulaglutide. Pioglitazone was superior to vitamin E in
increasing the resolution of NASH. Furthermore, liraglutide treatment had the
highest SUCRA ranking in decreasing CAP and ELF scores and increasing the
resolution of NASH. Pioglitazone treatment had the highest SUCRA ranking in
decreasing LFC and fibrosis scores. Tofogliflozin treatment had the highest
SUCRA ranking in decreasing K-18, while dapagliflozin treatment had the highest
SUCRA ranking in decreasing the GGT level. Semaglutide treatment had the highest
SUCRA ranking in decreasing the levels of ALT and AST" See
delta tocotrienol at
Amazon.com.
-
Can
sodium-glucose co-transporter-2 (SGLT-2) inhibitor reduce the
risk of adverse complications due to COVID-19? - Targeting
hyperinflammation - Curr Med Res Opin 2022 Jan 20 -
"Sodium-glucose co-transporter-2
(SGLT-2) inhibitors are antidiabetic drugs with numerous
pleiotropic and positive clinical effects, particularly
regarding a reno-cardiovascular protective effect. More recent
studies, including from our laboratory, have highlighted some
novel anti-inflammatory activity of SGLT-2 inhibitors. This may
confer a theoretical advantage in mitigating excessive cytokine
production and inflammatory response associated with serious
COVID-19 infection. Specifically, earlier research has
demonstrated that SGLT-2 inhibitors are associated with a
notable decrease in inflammatory indicators, for example,
C-reactive protein, ferritin, and interleukin-6. Furthermore,
SGLT-2 inhibitors exhibit a favourable impact on the vascular
endothelium function; this could pertinence the prophylaxis of
the thrombotic issues that arise in SARS-CoV-2. This review
provides an overview of the COVID-19 indirect immune response
mechanisms impacting the cardiovascular system and the possible
effect of SGLT-2 inhibitors on the management of COVID-19"
- See
empagliflozin inhousepharmacy.vu.
-
Glucose-Lowering Medications and Post-Dementia Survival in
Patients with Diabetes and Dementia - J Alzheimers Dis 2022
Jan 13 - "glucose-lowering drugs (GLDs)
... Insulin and sulfonylurea carried higher mortality risk among
dementia patients, while GLP-1a and SGLT-2i were associated with
lower risk. GLD-associated mortality varied between dementia and
comparable dementia-free subjects"
-
Sodium-Glucose Cotransporter
2 Inhibitors, Glucagon-Like Peptide-1 Receptor Agonists, and Dipeptidyl
Peptidase-4 Inhibitors, and Risk of Hospitalization - Am J Cardiol 2021 Dec
19 - "SGLT2i was associated with substantially lower
risk of myocardial infarction and heart failure hospitalization compared with
DPP4i and lower risk of heart failure hospitalization compared with GLP-1RA"
- See
dapagliflozin at reliablerxpharmacy.com.
-
Beneficial Effect of
Sodium-Glucose Co-transporter 2 Inhibitors on Left Ventricular Function - J
Clin Endocrinol Metab 2021 Nov 15 - "Treatment with
SGLT2 inhibitors can significantly improve LV function in patients with or
without diabetes (especially those with HF or undergoing empagliflozin
treatment)" - See
dapagliflozin at reliablerxpharmacy.com. They don't carry
empagliflozin.
-
Clinical benefits of
empagliflozin in very old patients with type 2 diabetes hospitalized for acute
heart failure - J Am Geriatr Soc 2021 Nov 29 -
"There is little evidence on the use of sodium-glucose cotransporter 2 (SGLT2)
inhibitors in older patients with heart failure. This work analyzed the clinical
efficacy and safety of empagliflozin continuation in very old patients with type
2 diabetes hospitalized for acute decompensated heart failure ... In very old
patients with type 2 diabetes hospitalized for acute heart failure, continuing
preadmission empagliflozin reduced NT-proBNP levels and increased diuretic
response and urine output compared to a basal-bolus insulin regimen. The
empagliflozin regimen also showed a good safety profile" - See
dapagliflozin at reliablerxpharmacy.com. They don't carry
empagliflozin.
-
SGLT2 Inhibitors and the
Risk of Acute Kidney Injury in Older Adults With Type 2 Diabetes - Am J
Kidney Dis 2021 Nov 8 - "Among older adults with T2D,
initiation of an SGLT-2i was associated with a reduced risk of AKI compared to
initiation of a DPP-4i or GLP-1RA"
-
SGLT2 inhibitors: the
statins of the 21st century - Eur Heart J 2021 Nov 6 - Note: It
doesn't have the abstract buy I was thinking the same thing.
-
Comparison of effects of
SGLT-2 inhibitors and GLP-1 receptor agonists on cardiovascular and renal
outcomes in type 2 diabetes mellitus patients with/without albuminuria: a
systematic review and network meta-analysis - Diabetes Res Clin Pract 2021
Nov 12 - "It remains unclear which sodium-glucose
cotransporter-2 (SGLT-2) inhibitors and glucagon-like peptide-1 receptor
agonists (GLP-1 RAs) are most effective for preventing cardiovascular and renal
events in type 2 diabetes mellitus (T2DM) patients, depending on the presence of
albuminuria ... SGLT-2 inhibitors may be superior to GLP-1 RAs for renal
outcomes in T2DM patients with/without albuminuria, although there was no
difference in the risk of MACE"
-
Association between SGLT2
Inhibitors vs DPP-4 Inhibitors and Risk of Pneumonia Among Patients with Type 2
Diabetes - J Clin Endocrinol Metab 2021 Nov 8 -
"Compared to DPP4is, SGLT2is use was associated with a reduced risk of pneumonia
and pneumonia mortality in a real-world setting"
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